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About Our Organ Transplant Team
Clinical organ transplantation has had a long history in Taiwan. In 1968 Prof. Chun-jean Lee from National Taiwan University College of Medicine led a surgical team in performing Asia’s first successful living-donor kidney transplant. In the following year, his team completed the country’s first cadaveric kidney transplant. These achievements marked a new era for the country and laid a solid foundation for National Taiwan University Hospital (NTUH) in the area of organ transplantation.
Building on the success with kidney transplants, NTUH began to develop expertise in the transplantation of other organs as well. Currently the hospital routinely performs transplantation of the heart, liver, kidney, lung and pancreas.
A total of 1,200 kidney transplants have been successfully performed at NTUH thus far. In recent years, retroperitoneoscopic donor nephrectomy has been used to harvest kidneys donated by patients’ family members. This procedure results in less tissue damage compared with the conventional laparoscopic approach, thus facilitating the resumption of donors’ normal activities. Kidney transplants have in the past been carried out only between donors and recipients of compatible blood types, and many patients had to give up hope when no compatible donors were available. Since 2000, transplants on patients of incompatible donor blood type and positive crossmatch have been performed successfully, at a technical level on par with world standards. Traditional practices require a kidney recipient to undergo splenectomy to reduce the risk of rejection if his or her blood type is incompatible with the donor’s. This induces an additional surgical procedure, not to mention added risk of infection. In 2006 the hospital successfully completed an ABO-incompatible kidney transplant without removing the recipient’s spleen, which represents a milestone for transplantation immunization.
Taiwan’s first heart transplant surgery was performed at NTUH in 1987, and the first successful simultaneous heart-kidney transplant was carried out there in 1995. In 2000, a successful heart transplant was performed on a five-month-old infant, and in 2003 a simultaneous pediatric heart-kidney transplant was completed. The longest surviving heart transplant recipient has lived over 20 years since the surgery.
NTUH’s first successful lung transplantation was performed in 1995, and the longest surviving lung transplant patient has lived more than 20 years. In addition, the heart and lung transplantation teams joined forces in 1999 to carry out a cardiopulmonary transplant, making NTUH the only leading medical institution in Taiwan capable of performing single-lung, pulmonary lobe, double-lung and cardiopulmonary transplantation. To address the shortage of donated organs, NTUH has been approved by the Ministry of Health and Welfare to begin conducting human trials on living-donor pulmonary lobe transplantation. It is hoped that through this project, the hospital’s living-donor transplantation capability will be greatly improved in the near future.
NTUH formally launched the liver transplantation program in October 1989. Initially the focus was on cadaveric liver transplantation; which applied mainly to treating diseases such as primary biliary cirrhosis, cirrhosis caused by hepatitis B and C, and congenital biliary atresia; achieving a surgery success rate of over 90%. Transplant patients include those who underwent simultaneous liver and kidney transplantation, those with pulmonary arterial hypertension, and those with portal vein thrombosis from having undergone multiple surgeries. These were the first liver transplantation cases in Taiwan. Liver transplantations for children and adults have been carried out in NTUH since 1997 and 2000 respectively, with a success rate of 92.7%. Living-donor liver transplantation now provides some relief to the current liver donor shortage problem as well as the treatment of end-stage liver diseases and fulminant hepatitis in adults.
Pancreatic transplantation provides type 1 (“youth”) diabetes patients with insulin-secreting beta cells. Although these patients can control their blood glucose levels by injecting insulin, they are unable to maintain a healthy level at all times and often suffer from complications leading to renal failure. Pancreatic transplantation can be conducted in one of two ways: pancreatic islet cell transplant and whole-organ transplant. NTUH has achieved excellent clinical results on whole-organ transplantation, the more commonly employed method at the hospital. We began to perform pancreatic transplants in 1984. Currently we perform simultaneous kidney-pancreas transplantation, pancreas after kidney transplantation, and pancreatic autotransplantation, with good postoperative results and significantly improved quality of life for the patients, who can now enjoy a life free from the shackles of insulin injection and dialysis.
The goal of our transplant team is “being able to change every single organ.” With pancreatic transplantation techniques now mature, we have begun to work on small bowel (intestinal) transplantation. Despite organ donor shortage, a fact of life for the foreseeable future, the transplant team is motivated to apply various methods to find solutions for our patients. Cell transplantation is another possibility for solving the shortage problem. At present, National Taiwan University is conducting animal experiments on the extraction of pancreatic islet cells, with the hope of transplanting islet cells from donors into diabetic patients in the future. We have also carried out animal experiments on stem cell transplantation to treat liver failure in hopes of helping more patients that are suffering from this disease.
With transplant surgery advancing rapidly in recent years, NTUH has devoted considerable resources in the research of immunization and organ preservation relevant to organ transplantation. We have established a clinical immunology core laboratory to study and better understand transplantation rejection. Plans are also underway at NTUH to establish an organ transplantation and cell technology center, with a view to further advancing transplantation technology and ushering in a new era of transplant medicine in this country.